Inside Health

By DAVID E. SANGER; Rick Lyman contributed reporting from Ottumwa, Iowa, for this article.

Published: September 14, 2004

President Bush sped across southwest Michigan on Monday, assailing Senator John Kerry for plans that he said would result in nationalized health care. Mr. Bush also defended his proposal to privatize part of Social Security, saying longstanding Democratic contentions that it would undercut the system amounted to ''the most tired, pathetic way to campaign for the presidency.''

Mr. Bush's characterizations of Mr. Kerry and his plans seemed to grow more heated as the president moved from rally to rally during his 21st visit to this state, which he narrowly lost in 2000. Polls show him running slightly behind Mr. Kerry in the state, but Mr. Bush's campaign aides say that the president's lead in national polls gives them a new opportunity to capture Michigan's 17 electoral votes.

Mr. Bush never explicitly compared Mr. Kerry's health care plans to those advocated by President Bill Clinton and Hillary Rodham Clinton in the early 1990's, which turned into a political liability for the Democrats. But he came close.

''What would you expect from a senator from Massachusetts?'' he asked Monday morning in Muskegon, his first stop. ''That's what you would expect -- a government takeover of health care with an enormous price tag.''

Speaking at three different events to thousands of enthusiastic supporters, Mr. Bush focused on domestic issues, particularly health care, and portrayed Mr. Kerry as a traditional, big-government liberal.

''I'm running against a fellow who has got a massive, complicated blueprint to have our government take over the decision-making in health care,'' the president said. ''Not only is his plan going to increase the power of bureaucrats in your life, but he can't pay for it unless he raises your taxes.''

On Tuesday the Republican National Committee will begin running an advertisement that hits the same theme. It ends with a voice-over intoning: ''Big government in charge. Not you. Not your doctor.''

Mr. Kerry's campaign officials on Monday called that characterization a fabrication and a deliberate distortion. ''It's ridiculous,'' said Sarah Bianchi, the policy director for the Kerry campaign, in a telephone call to reporters who were traveling with Mr. Bush. ''The reason he is doing it is that he doesn't have a plan; he has a failed record.''

Ms. Bianchi said of Mr. Kerry's plan: ''It gives small business a tax credit to buy health insurance. The last time I checked, tax cuts for small businesses is not nationalized health care.'' Under the plan, the government would pay for 75 percent of the premiums for catastrophic health care -- that is, coverage for very expensive, nonroutine care. It would pay for that by rolling back the tax cuts passed early in the Bush administration for those earning more than $200,000 a year.

At every stop, Mr. Bush also called for limits on lawsuits against doctors, which he said ''costs the taxpayers about $28 billion a year for docs to practice medicine defensively.''

''You ask docs what it's like to practice in a litigious society,'' Mr. Bush said, stopping to mock his own use of a large word. ''That means there's a lot of lawsuits. I'm not even a lawyer and I know the word 'litigious.'''

At a town hall meeting in southeastern Iowa, Vice President Dick Cheney hammered away with a similar theme. He pointed to a study of Mr. Kerry's health care proposals released earlier on Monday as proof that the Democratic nominee would raise taxes if elected.

The study, by the American Enterprise Institute, a conservative policy group for which the vice president's wife, Lynne, once worked, concluded that Mr. Kerry's health plan would cost $1.5 trillion.

''There is not any way you can have a program that large and pick up that much cost without ultimately creating the need for generating large taxes, probably across the board,'' Mr. Cheney said.

At each stop Mr. Bush said that he and other members of the baby-boom generation -- he was at the very start of that group -- had nothing to worry about when it came to Social Security. But he said Democrats were pursuing a scare campaign about his plan to privatize part of the Social Security system that would let younger workers invest some of their Social Security contributions into personal accounts that could go into the equity or bond markets.

''You'll hear the same rhetoric you hear every campaign, believe me,'' he said. '''They're going to take away Social Security checks.' It's the most tired, pathetic way to campaign for the presidency.''

The Kerry campaign responded, through a spokesman, Phil Singer, that ''the only thing that's tired and pathetic is George Bush's warmed-over Social Security privatization plan from 2000 that jeopardizes the program, cuts benefits and results in a $2 trillion deficit.''

On Tuesday Mr. Bush is to travel to Colorado and Las Vegas, where he is scheduled to address the annual convention of the National Guard Association.

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Cheney Speaks on School Killings

(By The New York Times), OTTUMWA, Iowa, Sept. 13 -- Mr. Cheney said Monday that last week's massacre at a school in the southern Russian town of Beslan had caused some foreign leaders who have been skeptical of America's aggressive foreign policy to reconsider.

''Some of our European friends have been somewhat ambivalent,'' Mr. Cheney told a town hall meeting inside an airport hangar on the outskirts of this small town in southeast Iowa. He mentioned no nations by name.

Some foreign countries have probably been thinking that ''if they kept their heads down,'' their citizens would not suffer terrorist attacks, the vice president said. ''Well, Russia got his anyway,'' he said.

As a result, Mr. Cheney said, ''people are reassessing now'' whether they should shed their ambivalence and openly support Mr. Bush's policies.

Photo: President Bush, yesterday in Muskegon, Mich., criticized John Kerry's health care plan and defended his own Social Security proposal. (Photo by Richard Perry/The New York Times)